相位角对实体肿瘤患者手术、化疗期间营养治疗的定量分析及对预后早期评估的价值

Quantitative analysis of nutritional therapy during surgery and chemotherapy and its value for early evaluation of prognosis

目的:使用生物电阻抗分析对肿瘤患者围治疗期不同阶段进行评估,分析不同时期的体成分特点,寻找有效、早期的营养不良预警指标及预后评估指标。方法:采用人体成分分析仪对患者进行人体成分测定,收集正常人群的体成分数据作为对照组,手术治疗后、短期内不能进食且依赖早期开展肠内/肠外营养治疗的肿瘤患者的体成分数据为手术组,手术组患者恢复出院后并进行化疗的肿瘤患者体成分数据作为化疗组,分析三组体成分的特点及变化趋势,通过相关性分析寻找营养风险患者的早期预警指标,并根据受试者工作特征曲线(receiver operating characteristic curve,ROC)筛选早期评估预后的指标及寻找最佳临界值。结果:手术治疗组相比对照组相位角降低(P<0.001),生存系数绝对值降低(P<0.001),化疗组相比对照组,蛋白质含量、骨骼肌质量、相位角较对照组明显下降(P=0.002、P=0.001、P<0.001),生存系数绝对值降低(P<0.001);手术组营养前后配对分析发现营养治疗后相位角上升(P=0.004),生存系数绝对值上升(P<0.001);相关性研究发现术后患者营养治疗前和化疗组患者相位角和SOFA评分、营养筛查NRS2002评分呈明显负相关(r=-0.4808、P<0.0001;r=-0.5434、P<0.0001),另外相位角和生存系数呈明显负相关(r=-0.6745、P<0.0001);单因素分析发现相位角及生存系数在预测手术组患者住院时间长短方面具有良好的优势(ROC-AUC 0.879,P<0.001;ROC-AUC 0.843,P<0.001),而将SOFA评分、相位角、生存系数联合起来进行多因素分析,预测患者住院时间,得到最大的曲线下面积0.927,约登指数0.751。结论:相位角在预测患者营养风险、评估营养治疗效果上更有优势,而且相位角与病情严重程度相关,能够反应细胞及器官的功能状态。另外,相位角和生存系数对接受手术治疗的肿瘤患者住院时间具有较好的预测价值。

Objective:Bioelectrical impedance analysis is utilized to assess various populations,enabling a comprehensive comprehension of body composition attributes among distinct groups.Moreover,it aids in the identification of effective and timely indicators for malnutrition warning and prognostic evaluation.Methods:The body composition of patients was determined by body composition analyzer,and body composition data of normal population was collected as the control group.The body composition data of tumor patients who could not eat in a short period after surgical treatment and relied on early enteral/parenteral nutrition therapy were classified as the operation group.The body composition data of tumor patients who recovered from the surgery group and underwent chemotherapy after discharge were classified as the chemotherapy group.The characteristics and trends of body composition in the three groups were analyzed,and the early warning indicators of patients with nutritional risk were sought through correlation analysis,and the indicators of early prognosis assessment and the optimal critical value were screened according to the receiver operating characteristic curve(ROC).Results:Compared with the control group,the phase angle and absolute survival coefficient of the surgical treatment group were decreased(P<0.001).Compared with the control group,the protein content,skeletal muscle mass and phase Angle of the chemotherapy group were significantly decreased(P=0.002,P=0.001,P<0.001),the absolute survival coefficient decreased(P<0.001).The paired analysis before and after nutrition in the operation group found that the phase angle increased after nutrition treatment(P=0.004),and the absolute survival coefficient increased(P<0.001).The correlation study found that the phase angle of patients before nutritional treatment after surgery and patients in chemotherapy group were 0x09 significantly negatively correlated with SOFA score and NRS2002 score of nutritional screening(r=-0.4808,P<0.0001;r=-0.5434,P<0.0001),and the phase angle was negatively correlated with the survival coefficient(r=-0.6745,P<0.0001).Univariate analysis showed that phase Angle and survival coefficient had a good advantage in predicting the length of hospital stay in the operation group(ROC-AUC 0.879,P<0.001;ROC-AUC 0.843,P<0.001),while SOFA score,phase Angle and survival coefficient were combined to predict the length of hospital stay,and the maximum area under the curve was 0.927,and the Yoden index was 0.751.Conclusion:The phase angle offers numerous advantages in predicting patients'nutritional risk and assessing the effectiveness of nutritional therapy.Additionally,it is significantly associated with the severity of the patient's condition and can effectively reflect the functional status of cells and organs.Moreover,both the phase angle and the absolute survival coefficient demonstrate a strong predictive value for determining the length of hospital stay in critically ill cancer patients undergoing surgical treatment.